Should physicians disclose the stage and severity (e.g., Stage III‑C) of a uterine cancer diagnosis to the patient at the time of diagnosis, or is withholding that information permissible?

Physician Obligation to Disclose Cancer Stage and Severity

Physicians are obligated to inform patients of their cancer stage and severity at the time of diagnosis; withholding this information violates the patient's fundamental right to know and undermines the foundation of informed consent and autonomous medical decision-making.

Legal and Ethical Framework

The determination and documentation of disease extent is a prerequisite activity in starting the process of cancer care, and cancer stage should be defined and recorded at initial diagnosis 1. This information must remain unchanged in the medical records 1.

Patient Right to Information

• Patients have an inherent right to know the truth about their diagnosis, including the anatomical extent of disease (stage) 2.
• Any patient who desires to know the nature of their disease has a right to be told 2.
• The announcement of cancer diagnosis represents an important moment in establishing the doctor-patient relationship and must come with quality communication 3.
• This disclosure is never insignificant and represents the start of a full therapeutic act that seals the pact of trust between doctors and patients 3.

Clinical Staging Requirements for Uterine Cancer

For the specific case of uterine (endometrial) cancer Stage III-C:

Stage III-C Definition and Implications

• Stage IIIC involves metastasis to pelvic (IIIC1) or para-aortic (IIIC2) lymph nodes, representing advanced disease with significant prognostic implications 4, 5.
• Stage III endometrial cancer carries a significantly worse prognosis than stage I-II disease 6.
• Knowledge of stage is frequently important for treatment decision-making, including determining eligibility for clinical trials and selecting appropriate multimodal therapy 1.

Treatment Planning Requires Stage Disclosure

• Stage IIIC disease requires platinum-based chemotherapy (carboplatin/paclitaxel or cisplatin/doxorubicin) as standard treatment, which significantly improves progression-free and overall survival 4.
• Pelvic radiotherapy may be added to increase locoregional control 4.
• The combination of surgery, radiotherapy, and chemotherapy offers the best chance for cure in stage III patients 6.
• Treatment should be pursued with curative intent despite the advanced local stage 6.

Why Withholding Stage Information Is Impermissible

Informed Consent Cannot Exist Without Full Disclosure

• Patients cannot provide informed consent for radical treatments (surgery, radiation, chemotherapy) without understanding the stage and severity of their disease 2.
• Withholding information deprives patients of the liberty to make autonomous decisions about their final days and treatment preferences 7.
• If treatment fails, patients who were not fully informed may feel furious and frustrated that they were deprived of the ability to make informed choices 7.

"Therapeutic Nondisclosure" Is Not Justified

• The practice of "therapeutic nondisclosure"—withholding diagnostic or prognostic information to protect patients from perceived harm—has been increasingly rejected in modern medical practice 8.
• Trends over the last 30 years in the United States have moved toward more complete disclosure of cancer-related information, driven by patient rights movements and ethical evolution 8.
• Arguments for nondisclosure based on protecting patient hope or avoiding psychological harm have been deconstructed and called into question 8.

Multiple Stakeholders Require Stage Information

• Stage information is used by clinicians and patients when estimating prognosis and selecting treatments, by researchers for clinical trial eligibility, and by cancer control professionals 1.
• The anatomical extent of disease should be available to the clinician and collected as a separate and distinct variable 1.

Practical Approach to Disclosure

When and How to Disclose

• Disclosure should occur at the time of diagnosis, with the stage designation recorded and remaining unchanged in medical records 1.
• The announcement must observe rules of temporality and take into account the psychological defense mechanisms of the patient 3.
• Information should be provided in a way that oscillates between appropriate distance and proximity while respecting the patient's autonomy, dignity, and freedom of choice 3.

Addressing Family Requests for Nondisclosure

• When family members request withholding information (as commonly occurs in certain cultural contexts), the physician should compassionately explain that the patient's right to know supersedes family preferences 8.
• The clinician should approach such requests in a compassionate and respectful way while ultimately prioritizing the patient's autonomy 8.

Common Pitfalls to Avoid

• Never withhold stage information based on assumptions about what the patient can handle psychologically—this violates patient autonomy and informed consent 8.
• Do not confuse "breaking bad news gently" with "withholding critical staging information"—compassionate communication does not mean incomplete disclosure 3.
• Avoid deferring staging discussions until treatment planning—patients need this information immediately to understand their prognosis and make informed decisions 1.
• Do not allow cultural preferences of family members to override the patient's right to know—while cultural sensitivity is important, patient autonomy is paramount 8.

Legal Considerations

• Withholding stage information creates legal liability, as full disclosure helps avoid legal action related to inadequate informed consent 2.
• The physician's legal obligation to provide complete information is increasingly recognized, with future lawyers more likely than future physicians to emphasize legal obligations to disclose 9.